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APPLICATION FOR SANITATION PERMIT Permit No. .__ �_l_l_ -- r�� (Complete in Duplicate) Date Issued .__��_ Application is hereby made to the San Joaquin Local Health District for a permit to construct and install t e*ork herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESSAND R ------------- LOCATIO .. _ ___ ______ Owner's Name-•--------- - - ----- ---- .. Phone--------- Address----------------------f 110 P•19, Contractor's Name-------------------- ---------- lL -----. Phone-- �IInstallation will serve: Residence R3'Apartment House,❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _.l--_ Number of bedrooms , ._ Number of baths _1___ Lot size Water Supply: Public system ❑ Commun'ity system riva'te ❑ Depth to Water Table �Z ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ®---F-lardpan [] Previous Application Made: Yes ❑ No gr'--New Construction: Yes Er-'No ❑ FHA/VA: Yes P--`Po ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-----'_�' _Distance from foundation----/V---------Material___ No. of compartments_.___,.2m 4-�X-41.Q-_...Liquid depth-_6.1 -� _ p y__ -------------Size__ Ca acit f"__�--- Disposal Field: Distance from nearest well---- ----._Distance from foundation___4K_�___--.Distance to nearest lot line•-__S--_____--- Number of lines---------�_._. 10' _ ------------------Length of each line___-- ► `'_-_____-.Width of trench---_ �!-_-____---__ Type of filter material/j_/fPeP4&/---Depth of filter material------Z /'___Total length-----!`%._V_ ------------------- Seepage --____.________ r - See.a e Distance to nearest well----_________--------Distance from foundation---•��_.......Distance to nearest lot line__ p 9 � . Number of its-_--_ _ p� p� �.-----------Lining material_____/eejj!,,dSize: Diameter---4,f&_ _______Depth_.._.�_�___�f�'� .� s Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-_-_--_----_----__.._-_____-_---. s ' ❑ Size: Diameter-------------------------,-- ----.-Depth----------------------------------------------------Liquid Capacity---------------------------gals. OV Privy: Distance from nearest well______________________________________________'_-_Distance from nearest buildin ❑ Distance to nearest lot line------------------------------------------',– (O Remodeling and/or repairing (describe):-----------------e ----------------------------------.------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------•-----•------------------------------•----•-----------------------------•---------------------------------------- 1 I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations ooftthe San Joaquin Local Health District. 5- (Signed)--------------------------------- A a--4z„----------------------------------------------------------------------- ----- ractor) By:----------------------------------------------- ----- Title (Plot plan, showing size of lot, location ot stem in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------_�-1R-0--"--------------------------------------------------------------------- DATE------- REVIEWEDBY - - ------------------ DATE------------------------------------------------ BUILDING PERMIT ISSUED-------------------------------------------------------------- -------- DATE _=--- Alterations and/or recommendations: - - � --•- --------------------- ______________---------------___ _______� ...__. _C___7_..rT. ______ ]..._:_e___.l_�________S_____,_'___-_i /_ ! _,�2!_-___-___l_-,t {,ns.�„______?� l__ ___f._.____._____.;_•__.... _ b460--------- ............ --------------------------------------------------- ----------------------- ----------- ------------- - ----------------------------------- L FINAL INSPE, N - Date-----L_�--- ---- J - SAN JOAQUIN LOCAL HEALTH DISTRICT 1 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street j Stockton, California Lodi, California Manteca, California Tracy, California ! ES-9-2M Revised 7.57 F.P.CO.